Journal of the American Academy of Dermatology
-
J. Am. Acad. Dermatol. · Feb 2008
ReviewTreating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings.
Chronic wounds are a major healthcare problem costing the United States billions of dollars a year. The American Academy of Dermatology has underscored the significance of wound care in dermatological practice. It is critical for all dermatologists to understand the elements of diagnosis and therapy. We emphasize major aspects of diagnosis and present a simple classification of wound dressings with guidelines for usage and relative cost data. ⋯ After completing this learning activity, participants should be able to diagnose common types of chronic wounds, formulate a therapeutic plan, and describe the major classes of topical therapies and dressings for the chronic wound.
-
J. Am. Acad. Dermatol. · Feb 2008
Review Case ReportsThe exanthem of dengue fever: Clinical features of two US tourists traveling abroad.
Dengue fever is the most common identifiable cause of acute febrile illness among travelers returning from South America, South Central Asia, Southeast Asia, and the Caribbean. Although the characteristic exanthem of dengue fever occurs in up to 50% of patients, few descriptions of it are found in the dermatology literature, and discussions of how to distinguish the dengue exanthem from other infectious disease entities are rare. Chikungunya fever is an emerging infectious disease now seen in returning US tourists and should be considered in the differential diagnosis of dengue fever in the appropriate patient. ⋯ Dengue fever should be considered in the differential diagnosis of fever and rash in the returning traveler. Dermatologists should be aware of the distinctive exanthem of dengue fever. Recognition of the dengue fever rash permits a rapid and early diagnosis, which is critical, as dengue fever can progress to life-threatening dengue hemorrhagic fever or dengue shock syndrome.
-
J. Am. Acad. Dermatol. · Feb 2008
ReviewLaser treatment of pediatric vascular lesions: Port wine stains and hemangiomas.
Pediatric vascular lesions can be medically threatening and psychologically distressing to patients. This article reviews literature on the laser treatment of two common pediatric vascular lesions, port wine stains and hemangiomas. ⋯ Overall, port wine stain laser treatment promoted notable clearing with low side effects, whereas hemangioma laser treatment provided inconsistent benefits and severe side effects occasionally. Laser treatment of port wine stains is safe and effective, but laser treatment of hemangiomas remains controversial and is best for lesions without deeper components.
-
J. Am. Acad. Dermatol. · Dec 2007
Randomized Controlled Trial Multicenter StudyVaccination strategies for the prevention of herpes zoster and postherpetic neuralgia.
Herpes zoster disease and its most common complication, postherpetic neuralgia, are associated with significant morbidity in the elderly. The zoster vaccine boosts cell-mediated immunity to varicella-zoster virus, the virus that causes both varicella and herpes zoster. ⋯ Widespread use of this vaccine could prevent as many as a quarter of a million cases of zoster disease each year. The design and outcomes of the Shingles Prevention Study, which examined the efficacy and safety of the vaccine, and the rationale for widespread immunization against varicella-zoster virus, are presented here.
-
Patients with herpes zoster experience severe pain and potential lasting complications such as postherpetic neuralgia, ophthalmic disease/damage, and, rarely, skin complications (eg, infection of rash area). Treatment for acute zoster aims to accelerate healing, control pain, and, when possible, reduce the risk of complications. Early intervention with antivirals can accelerate rash healing, reduce rash severity, and reduce the risk of some complications. ⋯ If a patient does develop postherpetic neuralgia, gabapentin, pregabalin, opioids, tricyclic antidepressants, lidocaine patch 5%, and capsaicin may all be considered as palliative treatments. For individuals with treatment-refractory postherpetic neuralgia, nonpharmacologic approaches may be considered and a pain-management specialist should be consulted. There is a need for more effective agents to treat herpes zoster and postherpetic neuralgia.